Browse > Article
http://dx.doi.org/10.14475/kjhpc.2016.19.1.70

Cases and Literature Review of Timing for Withdrawal of Palliative Chemotherapy  

Jeong, Yun Jin (Division of Hematology and Medical Oncology, Department of Internal Medicine, Ilsan Hospital, Dongguk University College of Medicine)
Kim, Do Yeun (Division of Hematology and Medical Oncology, Department of Internal Medicine, Ilsan Hospital, Dongguk University College of Medicine)
Publication Information
Journal of Hospice and Palliative Care / v.19, no.1, 2016 , pp. 70-75 More about this Journal
Abstract
Advanced incurable cancer patients receive palliative chemotherapy to prolong their life and improve quality of life. However, physicians should assess the timing to discontinue the treatment, especially near the final months of life, as palliative chemotherapy may accompany considerable toxicity. Even though there are no clear guidelines regarding the withdrawal timing for anticancer treatment in palliative setting, it is important clarify the issue for quality of care for advanced cancer patients. Here, we present two patients who received palliative chemotherapy for advanced colon cancer and non-small cell lung cancer, respectively. In both cases, it was jointly determined to stop palliative chemotherapy, and best efforts are made to relieve troublesome symptoms. The cases and up-to-date literature review will highlight the importance of the timing of discontinuation of cancer treatments when changes are being made to the health care system and hospice and palliative medicine is taking root in Korea.
Keywords
Antineoplastic agents; Palliative care; Terminal care; Quality of life; Withholding treatment;
Citations & Related Records
Times Cited By KSCI : 2  (Citation Analysis)
연도 인용수 순위
1 Rajagopal PS, Nipp RD, Selvaggi KJ. Chemotherapy for advanced cancers. Ann Palliat Med 2014;3:203-28.
2 Wright AA, Zhang B, Keating NL, Weeks JC, Prigerson HG. Associations between palliative chemotherapy and adult cancer patients' end of life care and place of death: prospective cohort study. BMJ 2014;348:g1219.   DOI
3 Emanuel EJ, Young-Xu Y, Levinsky NG, Gazelle G, Saynina O, Ash AS. Chemotherapy use among Medicare beneficiaries at the end of life. Ann Intern Med 2003;138:639-43.   DOI
4 Barbera L, Paszat L, Chartier C. Indicators of poor quality end-of-life cancer care in Ontario. J Palliat Care 2006;22:12-7.
5 Yun YH, Kwak M, Park SM, Kim S, Choi JS, Lim HY, et al. Chemotherapy use and associated factors among cancer patients near the end of life. Oncology 2007;72:164-71.   DOI
6 Keam B, Oh DY, Lee SH, Kim DW, Kim MR, Im SA, et al. Aggressiveness of cancer-care near the end-of-life in Korea. Jpn J Clin Oncol 2008;38:381-6.   DOI
7 Kao S, Shafiq J, Vardy J, Adams D. Use of chemotherapy at end of life in oncology patients. Ann Oncol 2009;20:1555-9.   DOI
8 Hong JH, Rho SY, Hong YS. Trends in the aggressiveness of end-of-life care for advanced stomach cancer patients. Cancer Res Treat 2013;45:270-5.   DOI
9 Sezgin Goksu S, Gunduz S, Unal D, Uysal M, Arslan D, Tatli AM, et al. Use of chemotherapy at the end of life in Turkey. BMC Palliat Med 2014;13:51.   DOI
10 Schnipper LE, Smith TJ, Raghavan D, Blayney DW, Ganz PA, Mulvey TM, et al. American Society of Clinical Oncology identifies five key opportunities to improve care and reduce costs: the top five list for oncology. J Clin Oncol 2012;30: 1715-24.   DOI
11 Ho TH, Barbera L, Saskin R, Lu H, Neville BA, Earle CC. Trends in the aggressiveness of end-of-life cancer care in the universal health care system of Ontario, Canada. J Clin Oncol 2011;29:1587-91.   DOI
12 Barnato AE, Herndon MB, Anthony DL, Gallagher PM, Skinner JS, Bynum JP, et al. Are regional variations in end-of-life care intensity explained by patient preferences?: A Study of the US Medicare Population. Med Care 2007;45:386-93.   DOI
13 Matsuyama R, Reddy S, Smith TJ. Why do patients choose chemotherapy near the end of life? a review of the perspective of those facing death from cancer. J Clin Oncol 2006;24: 3490-6.   DOI
14 Hui D, Karuturi MS, Tanco KC, Kwon JH, Kim SH, Zhang T, et al. Targeted agent use in cancer patients at the end of life. J Pain Symptom Manage 2013;46:1-8.   DOI
15 Johnston SC, Pfeifer MP, McNutt R. The discussion about advance directives. Patient and physician opinions regarding when and how it should be conducted. End of Life Study Group. Arch Intern Med 1995;155:1025-30.   DOI
16 Huang HL, Chiu TY, Lee LT, Yao CA, Chen CY, Hu WY. Family experience with difficult decisions in end-of-life care. Psychooncol 2012;21:785-91.   DOI
17 Wentlandt K, Burman D, Swami N, Hales S, Rydall A, Rodin G, et al. Preparation for the end of life in patients with advanced cancer and association with communication with professional caregivers. Psychooncology 2012;21:868-76.   DOI
18 Chunlestskul K, Carlson LE, Koopmans JP, Angen M. Lived experiences of Canadian women with metastatic breast cancer in preparation for their death: a qualitative study. Part II-enabling and inhibiting factors; the paradox of death preparation. J Palliat Care 2008;24:16-25.
19 Choi Y, Keam B, Kim TM, Lee SH, Kim DW, Heo DS. Cancer treatment near the end-of-life becomes more aggressive: changes in trend during 10 Years at a single Institute. Cancer Res Treat 2015;47:555-63.   DOI
20 Frigeri M, De Dosso S, Castillo-Fernandez O, Feuerlein K, Neuenschwander H, Saletti P. Chemotherapy in patients with advanced pancreatic cancer: too close to death? Support Care Cancer 2013;21:157-63.   DOI
21 Cherny NI, Sullivan R, Dafni U, Kerst JM, Sobrero A, Zielinski C, et al. A standardised, generic, validated approach to stratify the magnitude of clinical benefit that can be anticipated from anti-cancer therapies: the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS). Ann Oncol 2015;26:1547-73.   DOI
22 Zdenkowski N, Cavenagh J, Ku YC, Bisquera A, Bonaventura A. Administration of chemotherapy with palliative intent in the last 30 days of life: the balance between palliation and chemotherapy. Intern Med 2013;43:1191-8.   DOI
23 Baek SK, Kim SY, Heo DS, Yun YH, Lee MK. Effect of advanced cancer patients' awareness of disease status on treatment decisional conflicts and satisfaction during palliative chemotherapy: a Korean prospective cohort study. Support Care Cancer 2012;20:1309-16.   DOI
24 Kim DY. The impact of implementation to cancer patient's medical payment rate decreasing system on the health expenditure and m medical utilization of elderly colon cancer patients [master's thesis]. Seoul: Yonsei Univ.; 2008. Korean.